title: Functional and quality-of-life outcomes in patients undergoing transperineal repair with gracilis muscle interposition for complex rectourethral fistula.
abstract: OBJECTIVE
  To evaluate the results and quality of life outcomes of transperineal repair using gracilis muscle interposition in patients who were candidates for attempted preservation of bowel and bladder function. There is currently no widely accepted procedure for the treatment of complex RUF, such as those complicated by radiotherapy, previous attempts at repair, or large in size.
  
  
  METHODS
  Thirteen patients who underwent transperineal repair with gracilis muscle interposition for complex RUF were identified. Records were reviewed for fistula etiology, prior repair, intraoperative findings, hospital course, complications, diversion reversal, and outcome. Follow-up data were gathered from clinic visits and questionnaires.
  
  
  RESULTS
  Preoperative diagnoses included: prostate cancer (PCA) (12) and imperforate anus (1). Treatment for PCA included radical prostatectomy (4); brachytherapy (BT) (3); external beam radiation therapy (EBRT) + BT (3); cryoablation (1); and EBRT + cryoablation (1). Five patients underwent prior unsuccessful repair. There were no intraoperative complications. Postoperative complications included fecal incontinence (3) and bladder neck contracture (1). Nine patients (75%) reported some degree of urinary incontinence, with 2 patients reporting this as significant, defined as incontinence "most of the time." Suprapubic catheters were removed after 6 weeks, and median stomal reversal was at 17.5 weeks (12-28). One patient developed a recurrent RUF. All patients completed quality-of-life questionnaires assessing urinary and fecal outcome. Fecal outcome measures were generally better than urinary, but both were reasonable given the complexity of the situation.
  
  
  CONCLUSIONS
  Transperineal repair with gracilis muscle interposition is an effective treatment for selected patients with complex RUF. Our experience demonstrates low morbidity, high success rates, and reasonable bowel and bladder function postoperatively.
authors.affiliation: Center for Genitourinary Reconstruction, Glickman Urological and Kidney Institute, Cleveland Clinic Foundation, Cleveland, OH 44195, USA.
authors.forename: Mary K
authors.initials: MK
authors.lastname: Samplaski
authors.forename: Hadley M
authors.initials: HM
authors.lastname: Wood
authors.forename: Brian R
authors.initials: BR
authors.lastname: Lane
authors.forename: Feza H
authors.initials: FH
authors.lastname: Remzi
authors.forename: Armand
authors.initials: A
authors.lastname: Lucas
authors.forename: Kenneth W
authors.initials: KW
authors.lastname: Angermeier
mesh_terms: D000328:Adult; D000368:Aged; D005242:Fecal Incontinence / Q000209:etiology; D006801:Humans; D008875:Middle Aged; D018482:Muscle, Skeletal / Q000637:transplantation*; D011183:Postoperative Complications; D011788:Quality of Life; D019651:Plastic Surgery Procedures / Q000009:adverse effects / Q000379:methods; D012003:Rectal Fistula / Q000209:etiology / Q000601:surgery*; D014522:Urethral Diseases / Q000209:etiology / Q000601:surgery*; D014548:Urinary Fistula / Q000209:etiology / Q000601:surgery*; D014549:Urinary Incontinence / Q000209:etiology; D013520:Urologic Surgical Procedures / Q000009:adverse effects / Q000379:methods